Intent:
To determine a person’s ability to remember recent and past events (i.e., short-term and situational memory) and to perform sequential activities (procedural memory).
Definitions:
Short-term memory OK — Seems, appears to recall after 5 minutes
Procedural memory OK — Can perform all or almost all steps in a multitask sequence without cues
Situational memory OK — Both recognizes caregivers’ names/faces frequently encountered AND knows location of places regularly visited (bedroom, kitchen, etc.)
Process:
Short-term memory OK:
Conduct a structured test of short-term memory (preferred approach--see example below). If this is not possible, ask the person to describe a recent event that you should both have knowledge of (e.g., election of a new political leader, a major holiday) or that you can validate with a family member (e.g., what the person had for breakfast). If there is no positive indication of memory ability, code “1”, Memory problem.
Example of a Structured Approach for Assessing Short Term Memory
Ask the person to remember three unrelated items (e.g., book, watch, table) for a few minutes. After you have stated all three items, ask the person to repeat them to you (to verify that you were heard and understood by the person). Then proceed to talk about something else, such as going on to another part of the assessment. Do not be silent; do not leave the room. In five minutes, ask the person to repeat the name of each item. For persons with verbal communication deficits, non-verbal responses are acceptable (e.g., when asked to point to items that are to be recalled, he or she can do so). If the person is unable to recall all three items, code “1”, Memory problem.
Procedural memory OK:
This item refers to the cognitive ability needed to perform sequential activities.
Dressing is an example of such a task, as it requires multiple steps to complete the entire task. The person must be able to perform or remember to perform all or most of the steps in order to be scored as a “0" Memory O.K. If the person demonstrates difficulty in two or more steps, code as “1” Memory Problem. Note: People in need of care in the home often have physical limitations that impede their independent performance of activities. Do not confuse such physical limitations with the cognitive ability (or inability) to perform sequential activities.
Situational memory OK:
This two-part measure of orientation assesses the person’s cognitive ability to recognize both people and places. To be coded as OK, the person must BOTH recognize the names/faces of frequently encountered family members or caregivers AND know the location of places regularly visited (bedroom, dining room, other places visited outside the home). It is not necessary for the person to know the street number of the house or apartment but he/she should be able to find the way to his room, recognize the purposes of particular rooms, etc.
Coding:
Code for recall of what was learned or known. Code “Yes, Memory OK” if there are no indications of memory problems in both domains. IMPORTANT: For coding purposes, the person must demonstrate positive abilities in BOTH types of situations (i.e., caregiver names/faces AND locations) to be coded as “Yes, Memory OK”
Code “Memory Problem” if the person demonstrates difficulty in one or both areas.
Yes, memory OK
Memory problem
Examples
• Mrs. L. is a 90 year old former librarian who became a home care client 2 days ago, after being discharged from a rehabilitation hospital for continued OT and PT following surgical repair of a hip fracture. During the assessment Mrs. L. was articulate about her recent health history (including the names of the acute and rehabilitation hospitals, orthopedic surgeon, and primary nurses). She enumerated her current medication list and when the medications were to be taken, and reported that she did this activity without help. She introduced her 2 visiting daughters to the assessor by name. She also provided a brief social history. This information was validated as accurate via a conversation with her daughters, a review of the hospital discharge summary, and by review of the labels on the medication bottles.
Memory/Recall Ability Coding:
a. Short-term memory - (Yes, Memory OK)
b. Procedural memory - (Yes, Memory OK)
c. Situational memory - (Yes, Memory OK)
• Mr. I. is a 63 year old divorced gentleman with a 30 year history of alcohol abuse. Three weeks prior to intake into the home-care program, Mr. I. passed out while smoking in bed in his rented room, sustaining second degree burns of his left ear, neck and chest. He was admitted to an acute care hospital for treatment of burns, smoke inhalation, and delirium tremens. During the first few days of hospitalization he was resuscitated after a respiratory arrest and placed on mechanical ventilation for 5 days. He was transferred to a nursing facility 13 days ago and spent 10 days in a recuperative state.
During the admission assessment to the home care program, which occurred 2 days after his discharge from the nursing home, Mr. I. was able to recall the fire but was sketchy on the details of his hospitalization and treatment. He was unable to recall any of the three items posed to him during a test of his short-term memory. Mr. I. did relay information about his early life, including his 10-year marriage, the names of his 3 sons from whom he is now estranged, and his prior work as an accountant (information validated as accurate from his medical record). Mr. I. has been able to recognize the faces of his homemakers and of those providing care to him in the home and knows their roles (e.g., the nurse; the “therapist”). He can also find his way from his home, remember his rehabilitation and medical schedules, and prepares and eats lunch with no help from others.
Memory/Recall Ability Coding:
a. Short-term memory - (Memory problem)
b. Procedural memory - (Yes, Memory OK)
c. Situational memory - (Yes, Memory OK)